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Simultaneous recommendations by European experts echo US group’s guidance

10/15/2007By Craig Weatherby

Last week, we reported on findings by an expert American medical panel, which advised pregnant mothers to eat more fish than is recommended by the US government (See “Mothers and Kids Urged to Eat More Fish”).

Coincidentally, last week brought us news of similar recommendations for higher fish intake among pregnant women, this time from the European Commission (EC).

Key Points

New European guidelines echo US experts’ recent advice for mothers and infants.

Member associations shy from US experts’ advice that mothers eat more fish; Dissent indicates ignorance or deliberate avoidance of the best evidence.

The EC is the administrative arm of the European Union, and the new advice comes from its counterpart to the US Dept. of Health & Human Services.

The Europeans’ maternal fish-intake recommendations stemmed from the findings of two relevant research projects (Perinatal Lipid Metabolism and Early Nutrition Programming).

These were the EC panels’ consensus conclusions and recommendations:

Women and their fetuses are not getting enough omega-3 DHA from fish or fish oil, which is needed during pregnancy and infancy to ensure optimal brain and eye development.

Most studies indicate that higher intake of oily fish or fish oil during pregnancy and/or nursing yields better eye and brain development in babies.

Pregnant and nursing women should consume enough fish or fish oil to get at least 200 mg of omega-3 DHA per day (It is safe for them to take up to 1,000 mg of DHA per day).

Women can meet the recommended intake of DHA by eating one to two portions of oily fish per week, which will not exceed mercury-intake safety limits.

Plant-source omega-3s are far less effective for supplying DHA to the fetal brain, compared with the pre-formed DHA in fish and fish oil.

Pregnant women can safely consume up to 2.7 grams of total marine omega-3s (i.e., the combined amounts of omega-3 EPA and omega-3 DHA found in 4 to 8 oz of wild salmon).

Women should eat a wide range of species, but minimize intake of fish with the highest levels of mercury: swordfish, shark, tilefish, and king mackerel.

Some studies find that mothers who eat fish, fish oils or omega-3s have a slightly longer gestation time, a somewhat higher birth weight and a lower chance of premature delivery.

The European researchers emphasized that the benefits of fish consumption far outweigh the risks and that avoiding seafood carries its own dangers.

Like the Maternal Nutrition Group, in the US, whose advice we covered last week, the European researchers recommended eating a variety of fish and shellfish, especially the fatty species lowest in mercury, such as salmon and sardines.

(Note: Wild and farmed salmon are equally low in mercury, but wild salmon is much lower in PCBs, compared with farmed salmon.)

Larger, older members of predator species like tuna are relatively higher in mercury than most fish, but like wild salmon and sardines, our small, young tuna are exceptionally pure, as well as being high in omega-3s.

US medical panel’s recommendation met with some dissent

The fish-intake guidance we reported on last week was issued by the Maternal Nutrition Group (MNG): a panel of 14 leading professors of obstetrics and nutrition asked to review all relevant research and make recommendations for fish consumption among mothers, babies, and children.

The expert MNG panel was assembled by the directors of the National Healthy Mothers, Healthy Babies Coalition (HMHB), which is comprised of The American College of Obstetricians and Gynecologists (ACOG), The March of Dimes, The American Academy of Pediatrics (AAP), and several other major health associations.

The Maternal Nutrition Group’s experts reviewed the available scientific evidence and concluded that the documented rewards to developing babies outweigh the hypothetical risks of excess mercury consumption, even if their mothers eat much more fish than the US FDA and EPA recommend.

Advisories issued by the US FDA and EPA in 2004 for mothers and children counseled expectant mothers to consume a maximum of 12 ounces of fish or seafood per week (This is the amount in three normal servings of fish or shellfish).

In contrast, the “Healthy Mothers” guidelines issued last week by maternal health experts recommend a minimum of 12 ounces per week.

Now, The American College of Obstetricians and Gynecologists (ACOG) and The March of Dimes have distanced themselves from the new recommendation, saying that they will stick with the current FDA/EPA guidelines.

The chief bone of contention seems to be the decision of the MNG to omit advice from the FDA/EPA to avoid four high-mercury predator species: swordfish, shark, tilefish, and king mackerel.

We suspect that the MNG panel omitted this advice for the same reason they decided that the government’s guidelines are counterproductive; strong evidence that pregnant women’s intake of fish dropped dramatically after the warnings were issued in 2001 and again in 2004.

Perhaps the MNG experts felt that the likelihood of pregnant women eating much of the four high-mercury species—none of which is a common consumer choice—was so low that repeating the warning would only exacerbate the very fish-avoidance problem they sought to overcome.

Regardless of the reason for their omission, we tend to agree with the MNG’s critics that the expert panel should have reiterated the caution against these four uncommon species, if only to keep their member organizations fully on board and thereby avoid further controversy and confusion.

It didn’t help that the HMHB did not tell its member organizations that the announcement was coming: possibly because they feared that its high-profile member associations would ignore the evidence and support official US guidelines: a stance surer to avoid all criticism and controversy.

Nonetheless, we still support the thrust of the MNG’s advice, because it is based on the preponderance of the best-quality evidence.